Neonatal Atrial Flutter: Clinical Characteristics of 14 Cases in a Single Center

Purpose@#Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates. @*Methods@#The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively. @*Results@#All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge. @*Conclusion@#Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.

Association of Maternal Hypertensive Disorders During Pregnancy With Severe Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

Background@#This meta-analysis was performed to examine the association between maternal hypertension during pregnancy (HDP) and neonatal bronchopulmonary dysplasia (BPD). @*Methods@#We systematically searched PubMed, EMBASE, the Cochrane Library, and the KoreaMed database for relevant studies. We used the Newcastle-Ottawa Scale for quality assessment of all included studies. The meta-analysis was performed using Comprehensive Meta-Analysis software (version 3.3). @*Results@#We included 35 studies that fulfilled the inclusion criteria; the total number of infants evaluated came to 97,399 through review process. Maternal HDP was not significantly associated with any definition of BPD, i.e., oxygen dependency at 36 weeks of gestation (odds ratio [OR], 1.162; 95% confidence interval [CI], 0.991–1.362; P = 0.064) in pooled analysis of 29 studies or oxygen dependency at 28 days of age (OR, 1.084; 95% CI, 0.660–1.780; P = 0.751) in pooled analysis of 8 studies. Maternal HDP was significantly associated only with severe BPD (OR, 2.341; 95% CI, 1.726–3.174; P < 0.001). BPD was not associated with HDP in the overall analysis (OR, 1.131; 95% CI, 0.977–1.309; P = 0.100) or subgroup analysis according to the definition of HDP. @*Conclusion@#Maternal HDP was not associated with neonatal BPD defined by the duration of oxygen dependency (at either 36 weeks of gestation or 28 days of life) but was associated with severe BPD.

Intussusception in Neonates: Clinical Characteristics of Eight Cases in a Single Center

Purpose@#Intussusception is the most common cause of bowel obstruction in children; however, it is rarely diagnosed in newborn infants. This study aimed to describe the clinical features of intussusception in newborn infants. @*Methods@#Medical records of eight patients diagnosed with intussusception during the newborn period at Ulsan University Hospital between March 2007 and March 2020 were retrospectively reviewed. @*Results@#Among the eight cases, two occurred in the intrauterine period and six occurred in the postnatal period. Intrauterine intussusception presented with symptoms of bowel obstruction within 1 to 2 days after birth, and ileal atresia was diagnosed simultaneously through exploratory laparotomy. All the postnatal patients were extremely low birth weight infants (median gestational age and birth weight: 25+6 weeks and 745 g, respectively). Four cases were diagnosed preoperatively using abdominal ultrasonography. One patient was diagnosed by exploratory laparotomy because the clinical symptoms were nonspecific and difficult to differentiate from those of necrotizing enterocolitis, a more prevalent complication in preterm infants. The site of intussusception in all six patients was the small bowel. Meckel’s diverticulum (one case) and meconium obstruction (two cases) were found to be the lead point. @*Conclusion@#Neonatal intussusception tends to show different clinical features according to its period of occurrence. Intussusception, especially in preterm infants, has nonspecific clinical features; therefore, clinicians should always be cautious of this disease for its early diagnosis.

Intussusception in Neonates: Clinical Characteristics of Eight Cases in a Single Center

Purpose@#Intussusception is the most common cause of bowel obstruction in children; however, it is rarely diagnosed in newborn infants. This study aimed to describe the clinical features of intussusception in newborn infants. @*Methods@#Medical records of eight patients diagnosed with intussusception during the newborn period at Ulsan University Hospital between March 2007 and March 2020 were retrospectively reviewed. @*Results@#Among the eight cases, two occurred in the intrauterine period and six occurred in the postnatal period. Intrauterine intussusception presented with symptoms of bowel obstruction within 1 to 2 days after birth, and ileal atresia was diagnosed simultaneously through exploratory laparotomy. All the postnatal patients were extremely low birth weight infants (median gestational age and birth weight: 25+6 weeks and 745 g, respectively). Four cases were diagnosed preoperatively using abdominal ultrasonography. One patient was diagnosed by exploratory laparotomy because the clinical symptoms were nonspecific and difficult to differentiate from those of necrotizing enterocolitis, a more prevalent complication in preterm infants. The site of intussusception in all six patients was the small bowel. Meckel’s diverticulum (one case) and meconium obstruction (two cases) were found to be the lead point. @*Conclusion@#Neonatal intussusception tends to show different clinical features according to its period of occurrence. Intussusception, especially in preterm infants, has nonspecific clinical features; therefore, clinicians should always be cautious of this disease for its early diagnosis.

Erratum: Impact of Meconium Obstruction-Related Risk Factors on Surgical Intervention in Very Low Birth Weight Infants

We found an error in this article.

Impact of Meconium Obstruction-Related Risk Factors on Surgical Intervention in Very Low Birth Weight Infants

PURPOSE: This study investigated the risks of development and surgical complications of meconium obstruction (MO) in very low birth weight (VLBW) infants. METHODS: We performed a retrospective medical record review of VLBW infants admitted to the neonatal intensive care unit of Haeundae Paik hospital and diagnosed with MO of prematurity (MOP) between March 2010 and August 2013. RESULTS: Of 267 VLBW infants admitted to the neonatal intensive care unit, 28 were diagnosed with MOP. Perinatal factors including maternal pregnancy-induced hypertension and small for gestational age were associated with MOP development (P<0.05). Over two-thirds of VLBW infants with MOP were successfully treated with a gastrografin enema. The remaining eight VLBW infants required surgery. Although small for gestational age was more frequent in the medical treatment group, specific risk factors associated with MOP development did not affect the need for surgical intervention. CONCLUSION: MOP is common in VLBW infants, as most VLBW infants have risk factors for MOP. Identifying risk factors permits early diagnosis and initiation of appropriate medical treatment, reducing the necessity for surgery. However, the presence of specific risk factors does not increase risk of surgical complications.

Early Caffeine Use in Very Low Birth Weight Infants and Neonatal Outcomes: A Systematic Review and Meta-Analysis

The use of caffeine citrate for treatment of apnea in very low birth weight infants showed short-term and long-term benefits. A systematic review and meta-analysis of the literature was undertaken to document the effect providing caffeine early (0-2 days of life) compared to providing caffeine late (> or =3 days of life) in very low birth weight infants on several neonatal outcomes, including bronchopulmonary dysplasia (BPD). We searched MEDLINE, the EMBASE database, the Cochrane Library, and KoreaMed for this meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Jadad's scale. Studies were included if they examined the effect of the early use of caffeine compared with the late use of caffeine. Two reviewers screened the candidate articles and extracted the data from the full-text of all of the included studies. We included a total of 59,136 participants (range 58,997-59,136; variable in one study) from a total of 5 studies. The risk of death (odds ratio [OR], 0.902; 95% confidence interval [CI], 0.828 to 0.983; P=0.019), bronchopulmonary dysplasia (BPD) (OR, 0.507; 95% CI, 0.396 to 0.648; P<0.001), and BPD or death (OR, 0.526; 95% CI, 0.384 to 0.719; P<0.001) were lower in the early caffeine group. Early caffeine use was not associated with a risk of necrotizing enterocolitis (NEC) and NEC requiring surgery. This meta-analysis suggests that early caffeine use has beneficial effects on neonatal outcomes, including mortality and BPD, without increasing the risk of NEC.

Penile length, digit length, and anogenital distance according to birth weight in newborn male infants

PURPOSE: Anogential distance (AGD) and the 2:4 digit length ratio appear to provide a reliable guide to fetal androgen exposure. We intended to investigate the current status of penile size and the relationship between penile length and AGD or digit length according to birth weight in Korean newborn infants. MATERIALS AND METHODS: Between May 2013 and February 2014, among a total of 78 newborn male infants, 55 infants were prospectively included in this study. Newborn male infants with a gestational age of 38 to 42 weeks and birth weight>2.5 kg were assigned to the NW group (n=24) and those with a gestational age<38 weeks and birth weight<2.5 kg were assigned to the LW group (n=31). Penile size and other variables were compared between the two groups. RESULTS: Stretched penile length of the NW group was 3.3+/-0.2 cm, which did not differ significantly from that reported in 1987. All parameters including height, weight, penile length, testicular size, AGD, and digit length were significantly lower in the LW group than in the NW group. However, there were no significant differences in AGD ratio or 2:4 digit length ratio between the two groups. CONCLUSIONS: The penile length of newborn infants has not changed over the last quarter century in Korea. With normal penile appearance, the AGD ratio and 2:4 digit length ratio are consistent irrespective of birth weight, whereas AGD, digit length, and penile length are significantly smaller in newborns with low birth weight.

Hypereosinophilic Syndrome Presenting with Gastrointestinal Symptoms in an Adolescent / 계명의대학술지

Hypereosinophilic syndrome (HES) is defined as peripheral eosinophilia, organ involvement of eosinophils and exclusion of other disorders or dysfunction. HES is subclassified as myeloproliferative variant, T-lymphocytic, overlap, idiopathic, familial and associated type according to the new classification using molecular and immunologic markers. HES presenting with gastrointestinal symptoms is very rare but characterized by peripheral eosinophilia, eosinophilic infiltration of the gastrointestinal tract with other organs such as liver and bone marrow. We report a rare case of idiopathic HES in 18-year-old adolescent who presented with gastrointestinal symptoms including abdominal pain, diarrhea and ascites which resolved rapidly with corticosteroid therapy. HES should be included in the differential diagnosis of abdominal pain and ascites in children and adolescents.

A Simplified Formula Using Early Blood Gas Analysis Can Predict Survival Outcomes and the Requirements for Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia

The aims of this study were to investigate whether early arterial blood gas analysis (ABGA) could define the severity of disease in infants with congenital diaphragmatic hernia (CDH). We conducted a retrospective study over a 21-yr period of infants diagnosed with CDH. Outcomes were defined as death before discharge, and extracorporeal membrane oxygenation requirements (ECMO) or death. A total 114 infants were included in this study. We investigated whether simplified prediction formula [PO2-PCO2] values at 0, 4, 8, and 12 hr after birth were associated with mortality, and ECMO or death. The area under curve (AUC) of receiver operating characteristic curve was used to determine the optimum ABGA values for predicting outcomes. The value of [PO2-PCO2] at birth was the best predictor of mortality (AUC 0.803, P < 0.001) and at 4 hr after birth was the most reliable predictor of ECMO or death (AUC 0.777, P < 0.001). The value of [PO2-PCO2] from ABGA early period after birth can reliably predict outcomes in infants with CDH.

Persistent Pulmonary Hypertension of the Newborn in a Preterm Infant Exposed to Methotrexate During the Early Gestational Period / 대한주산의학회잡지

Methotrexate (MTX) is used in the reproductive aged females for the management of medical conditions such as ectopic pregnancy, autoimmune diseases and malignancies. Because of its antimetabolite effect, exposure to MTX during the fetal period can cause multiple anomalies. The most common anomalies related to intrauterine MTX exposure include growth retardation, craniofacial dysmorphism, central nervous system anomalies, cardiac anomalies and skeletal defects. We report a premature baby boy born after 27(+5) weeks of gestation who presented intrauterine growth restriction, single umbilical artery, small chest and anomalies of rib and thoracic vertebra. His mother had received 50 mg of MTX for the treatment of misdiagnosed ectopic pregnancy at 5th week of gestation. During the hospitalization, he was ventilator dependent and pulmonary hypertension persisted despite medical treatment including nitric oxide and sildenafil. Open lung biopsy revealed nonspecific findings suggestive of lung hypoplasia. He died at 141 days after birth due to respiratory failure.

Longitudinal Study of Iron Concentration in Korean Preterm Human Milk

PURPOSE: The unique nutrient requirements of premature infants necessitate knowledge of the composition of human milk produced by mothers of such infants. We investigated longitudinal changes in iron concentration of preterm human milk and compared to those observed in human milk of mothers of 1-week old term infants to determine optimal iron supplementation guidelines when preterm infants are nourished exclusively by breast feeding. METHODS: Human milk samples were collected at 1, 2, 4, 6, 8 and 12 weeks postpartum from 103 mothers who delivered infants of gestational age <34 weeks or weighing <1,800 g. Term human milk samples were collected at 1 week postpartum from 24 mothers. RESULTS: There were no significant differences in the iron concentrations of preterm human milk obtained at 2 to 8 weeks postpartum (36.3+/-23.1 to 45.8+/-26.0 microg/dL), but these concentrations were higher than those noted at 1 week in preterm (23.1+/-14.6 microg/dL) and term (25.2+/-7.55 microg/dL) infants. The iron concentration in preterm human milk obtained at corrected term age (42.2+/-19.4 microg/dL) was significantly higher than that of mature term human milk (25.2+/-7.55 microg/dL). CONCLUSION: The concentration of iron in preterm human milk was consistently low during the first 3 months of lactation. Supplementation with iron of at least 2 mg/kg/day should be considered for preterm infants who are exclusively breastfed and who have low body iron stores, to meet the minimum enteral iron requirements recommended by AAP-CON (2004).

Amplitude Integrated Electroencephalography in the Neonatal Intensive Care Unit for Diagnosis of Neonatal Seizure / 대한소아신경학회지

PURPOSE: To assess the usefulness of amplitude integrated electroencephalography (aEEG), we compared aEEG with electroencephalography (EEG), which is one of the most useful tools for assessment of neonatal seizures in the neonatal intensive care unit. METHODS: We retrospectively studied 24 neonates who had been suspected of seizure activity in the neonatal intensive care unit from January 2009 to February 2010. The 24 neonates had seizure or apnea that did not respond to aminophylline or continuous positive airway pressure. We compared the correlation and efficacy of diagnosis among aEEG, EEG, and neurosonography. RESULTS: We analyzed 24 aEEGs in the neonatal intensive care unit. The aEEGs showed a seizure pattern in 15 (62.6%), burst suppression pattern in 2 (8.3%), flat pattern in 4 (8.3%), and normal in 5 (20.8%). The results of EEGs showed 15 neonatal seizures (62.5%), 2 cerebral dysfunctions (8.3%), and 7 normal findings (29.2%). A correlation between aEEG and EEG was noted (P<0.05). However, there was no correlation between the results of aEEG and echoencephalography. CONCLUSION: There is correlation between aEEG and EEG for seizure detection in the neonatal intensive care unit. We think that aEEG is an useful screening tool for seizure detection in neonates.

Feeding Desaturation and Effects of Orocutaneous Stimulation in Extremely Low Birth Weight Infants

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.

Feeding Desaturation and Effects of Orocutaneous Stimulation in Extremely Low Birth Weight Infants

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.

The Role of Prenatal Target Ultrasonography in the Diagnosis of Congenital Anomalies in Infants of Diabetic Mothers / 대한주산의학회잡지

OBJECTIVE: Infants of diabetic mothers have higher incidence of congenital malformations compared with those of non-diabetic mothers. We investigated the usefulness of prenatal level II or "targeted" ultrasonography (TUS) as a diagnostic tool to identify congenital abnormalities in infants of diabetic mothers. METHODS: We retrospectively reviewed the medical records of 218 mothers diagnosed as pregestational or gestational diabetes in whom prenatal TUS was performed in Asan Medical Center between 2004 and 2009. The prenatal TUS findings were compared with the congenital abnormalities found in the infants (n=226) of the diabetic mothers by physical examination and ultrasonography (including echocardiography). Maternal risk factors associated with congenital anomalies were also investigated. RESULTS: The incidence of congenital anomalies was 14.2% (n=32) in prenatal TUS and 15.5% (n=35) postnatally, respectively. Only 7 cases (3.6%) out of the 194 infants with normal prenatal TUS findings were found to have congenital abnormalities diagnosed postnatally. All of the abnormalities in these 7 infants could be detected or suspected by physical examination after birth. Maternal fasting glucose level >120 mg/dL and insulin therapy were significant risk factors for predicting congenital abnormalities in infants of diabetic mothers. CONCLUSION: Prenatal TUS performed by experienced obstetricians had a good reliability in the diagnosis of congenital anomalies in infants of diabetic mothers. Need for universal screening of ultrasound or echocardiography in these infants should be questioned especially in the cases in which prenatal TUS was performed.

Incidence and outcome of congenital anomalies of the kidney and urinary tract detected by prenatal ultrasonography: a single center study / 소아과

PURPOSE: This study assessed the incidence and outcome of congenital anomalies of the kidney and urinary tract (CAKUT) detected by prenatal ultrasonography METHODS: There were 906 cases of CAKUT detected by prenatal ultrasonography and postnatally confirmed at the Asan Medical Center from October 1989 to October 2007. We investigated the incidence and outcome of these cases by reviewing medical records retrospectively. RESULTS: The order of incidence was hydronephrosis, multicystic dysplastic kidney (MCDK), duplex kidney, vesico-ureteral reflux (VUR), single kidney, hydroureteronephrosis, ectopic kidney, polycystic kidney, ureterocele, and posterior urethral valve (PUV). There were 520 cases (57.4%) of hydronephrosis, and 20% of these needed an operation due to significant obstruction. MCDK was associated with other CAKUT in 25.4% of all cases. Approximately 57.9% of duplex kidney cases needed surgical treatment due to ureterocele and VUR. VUR had a male: female ratio of 10:1. Two out of seven cases of autosomal recessive polycystic kidney had progressed to chronic renal failure. Patients with PUV were relatively uncommon, and one out of nine cases progressed to end-stage renal disease. CONCLUSION: CAKUTs detected by prenatal ultrasonography were composed of various anomalies, and almost all of them had a good outcome without any intervention. However, in some cases, recurrent urinary tract infection or renal failure occurred, especially in bilateral cases. For further management, a long-term multicenter study is needed to investigate the precise incidence and outcome of each anomaly in the general population.

Causative Agents and Antimicrobial Sensitivity of Neonatal Sepsis: Ten-year Experience in One Neonatal Intensive Care Unit

PURPOSE:To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. METHODS:We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. RESULTS:Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late- onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. CONCLUSION:The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.

Death in the Neonatal Intensive Care Unit

PURPOSE: Death is an important problem for physicians and parents in neonatal intensive care unit. This study was intended to evaluate the mortality rate, causes of death, and the change of mortality rate by year for infants admitted to the neonatal intensive care unit. METHODS: We retrospectively surveyed the medical records of the infants who were admitted to the neonatal intensive care unit at Asan Medical Center and who died before discharge between 1998 and 2007. Gestational age, birth weight, gender, time to death and the underlying diseases related to the causes of infant deaths and obtained from the medical records and analyzed according to year. RESULTS: A total of 6,289 infants were admitted and 264 infants died during the study period. The overall mortality rate was 4.2%. For very low and extremely low birth weight infants, the mortality rate was 10.6% and 21.4%, respectively. There was no significant change in the mortality rate during the study period. Prematurity related complications and congenital anomalies were the conditions most frequently associated with death in the neonatal intensive care unit. of the infant deaths 37.1% occurred within the first week of life. CONCLUSION: Even though a remarkable improvement in neonatal intensive care has been achieved in recent years, the overall mortality rate has not changed. To reduce the mortality rate, it is important to control sepsis and prevent premature births. The first postnatal week is a critical period for deaths in the neonatal intensive care unit.

A Case of Conjunctival and Corneal Calcification in a Child on Peritoneal Dialysis

Calcification in patients with endstage renal disease on renal replacement therapy can occur in extraskeletal area such as conjunctiva and cornea. Conjunctival and corneal calcification (CCC) has mostly has been reported in adults with endstage renal disease on hemodialysis. CCC seems to be associated with the duration of renal replacement therapy, and high CaxP value. We report a 10-year-old girl who was on peritoneal dialysis for 31 months and presented with CCC on both eyes. Her corneal calcification was resolved after the epithelial debridement and ethylenediaminetetraacetic acid(EDTA) soaking therapy.